垂体腺瘤患者正常垂体组织的MRI评估  

MRI study of pituitary tissues for pituitary adenoma patients

作　　者：田睿智 刘志红 舒南北 陈友明 雷霆[2] 王守森[3] 

机构地区：[1]武穴市第一人民医院神经外科,湖北武穴435400 [2]华中科技大学同济医院神经外科,湖北武汉430000 [3]南京军区福州总医院神经外科,福建福州350025

出　　处：《中华神经外科疾病研究杂志》2016年第4期325-329,共5页Chinese Journal of Neurosurgical Disease Research

基　　金：南京军区医学科技创新基金重点资助项目(11Z034)

摘　　要：目的评价垂体腺瘤患者的垂体组织在MRI上的信号和方位，分析其与垂体腺瘤病理类型之间的关系。方法回顾性分析具有完整临床资料的经鼻蝶入路垂体腺瘤切除术患者108例，在术前MRI上，依据平面直角坐标系测量垂体与垂体腺瘤的相对位置，将垂体按位置分为侧方型、上方型及侧上方型。术后观察尿崩情况，并于术后1周、术后4～6个月分别复查头颅MRI。结果在术前MRI T1平扫像上显示垂体亮点的86例中，垂体后叶相对于脑桥呈高信号的有53例，其中9例（17．0％）术后发生尿崩症；呈稍高信号的有20例，其中6例（30％）术后发生尿崩症；呈等信号的有13例，其中4例（30．8％）术后发生尿崩症。三组的尿崩发生率有统计学差异（P〈0．05）。无功能型腺瘤的垂体组织多位于侧方（64％），生长激素（GH）型腺瘤患者垂体组织多位于上方（56％），两组比较有统计学差异（P〈0．05）。108例垂体腺瘤患者中，65例在MRI上观察到垂体组织，部分病例术后垂体的体积恢复不满意，其中侧方型28例中有4例（14．3％），上方型和侧上方型37例中有13例（76．5％），两组比较有统计学差异（P〈0．05）。结论垂体腺瘤患者MRI上显示的垂体后叶信号强度与术后尿崩发生率呈负相关。生长激素型腺瘤者垂体组织位于肿瘤上方者较多；无功能型垂体腺瘤者，垂体组织位于肿瘤侧方者较多。术前垂体位于肿瘤侧方者，术后垂体组织体积恢复较好。Objective The MRI signal and orientation of pituitary tissue for the patients with pituitary adenomas are evaluated and their relation with pathological typing. Methods The medical records of 108 consecutive patients with pituitary adenomas who tmderwent transsphenoidal resection were analyzed retrospectively. On preoperative MRI, the plane rectangular coordinate system was used to measure the relative position of pituitary and pituitary adenoma, and the pituitary tissue was stratified as superior, superolateral or lateral. Diabetes insipidus was monitored pest-operation. Cranial MRI was performed at 1 w and 4 -6 months post-operation, respectively. Resatlts Among 86 eases with bright spot in the posterior pituitary lobe in pre-operative MRI, post-operative persisting diabetes insipidus was present in 9 （17%） of 53 patients in the high intensity signals group and in 6 （30%） of 20 patients in intermediate intensity signals group and in 4 （30. 8% ） of 13 patients in low intensity signals group. Patients in the low intensity signals group had a statistically significant higher rate of developing diabetes insipidus than those in the high intensity signals group （P 〈0. 05）. The displacement pattem of pituitary tissue tended to be lateral in non-functioning pituitary adenomas, and be superior in GH pituitary adenorms （P 〈 0. 05）. Conclusion Posterior pituitary signal intensity is negatively correlated with diabetes iusipidus. The displacement pattern of pituitary tissue tends to be lateral in non-functioning pituitary adenoma and be superior in GH pituitary adenomas.

关 键 词：垂体腺瘤 垂体 磁共振成像 手术 免疫组化 

分 类 号：R739[医药卫生—肿瘤]